Online Semi-Private Survey

FORM INSTRUCTIONS

Provide:

  1. Test date, test appointment time, and name of examiner.
  2. Family information, parent names, mailing address (to receive test materials/test results), and email.
  3. Student name(s), and grade level(s) to be tested.
  4. Check yes to order the optional Performance Evaluation Report. This report identifies specific objectives measured by all items on the test.
  5. Select the testing materials you are ordering to show the total cost. Testing fees will cover the following: Testing materials, basic report, and (if ordered) Performance Evaluation Report. Please note an additional processing fee of $8 is included in the price of testing for grades 1, 2, and 3.
  6. Click Submit. Your registration form will be submitted to Basic Skills and you be directed to a confirmation page.

After submitting the form and your payment, you will receive an email, sent to the email address that you provided on the form. This email will include a copy of the form for your records and reference.

"*" indicates required fields

Test Week and Parent/Guardian Name

Examiner*
Select date MM slash DD slash YYYY

Parent and Contact Information

Parents' Names
Mailing Address*

Students

First Student*
Select date MM slash DD slash YYYY
Performance Evaluation Report*
Are you registering a second student for this testing date?*
You may enter information for an additional student if you select Yes.

Test Selection and Order Total*

Please enter the quantity of each type of test and report you are ordering. Enter '0' to decline an item from your order.
Price: $88.00
Price: $80.00
Price: $15.00
*If any special pricing is active, the discount(s) will be applied at checkout even if regular prices are displayed.
Please select your payment method:
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
  
After you submit your payment information and this form, you will be taken to a landing page. The page contains instructions on making a payment, but if your payment went through here, there is no need to pay a second time. That landing page will remain while we update our systems. Thank you.
This field is for validation purposes and should be left unchanged.